CA2213384A1

CA2213384A1 - Dilatation/centering catheter

Info

Publication number: CA2213384A1
Application number: CA002213384A
Authority: CA
Inventors: Samuel F. Liprie
Original assignee: Angiorad LLC
Current assignee: Interventional Therapies LLC
Priority date: 1996-09-13
Filing date: 1997-08-20
Publication date: 1998-03-13
Also published as: AU3753497A; DE69718399T2; EP0829271A2; ES2190511T3; JPH10179751A; WO2001010502A1; US6234952B1; EP0829271A3; AU743684B2; AU7628500A; US5947924A; DE69718399D1; EP0829271B1

Abstract

An apparatus and method for treating an occlusion or constriction, such as a stenosis in a blood vessel or other conduit in the body, as well as an apparatus and method for treating a tumor or cancerous area occurring around a conduit or duct in the body. The apparatus includes a catheter provided with a centering balloon including a catheter centering balloon encircling a portion of the catheter near its distal end. This centering balloon contains a plurality of thin spoke-like members. A second dilatation balloon attached to the surface of the catheter is used to treat the stenosed area. A radioactive source of material is included for treating the stenosis or cancer.

Description

DILATATION/~NL~ING CAl~l~R USED FOR TXE TREATMENT
OF STENOSIS OR OTHER CONSTRICTION IN A BODILY PASSAGEWAY
AND MET~OD THEREOF

BACgGROUND OF THE INVENTION
S 1. Field of the In~ention The present invention relates to the field of treating ar. occlusion or a constriction, such as a stenosis which would occur in varicus blood vessels and other bodily conduits as well as to the field of angioplasty. Additionally, the present invention is directed to the field of treating cancer wh_ch would occur in various body conduiLs or ducts, as well as to the field o. k-achytherapy.

2. Description of the Prior Art Various techniques have been developed t_ treat many d_fferent conduits in the body when these conduits have become reduced in size due to the existence of a stenosis or have been completely occluded. These techniques include introaucing a deflatec balloon catheter to the site of an occlusion or constriction, such as a stenosis, inflating the balloon one or more times to eliminate the size of the stenosis, deflating the balloon and then removing the balloon catheter from the treatment site.
With respect to the vascular pathways, angioplasty is used to open an artery or blood vessel in the region where the stenosis or the occlusion has occurred. A typical angioplasty ~procedure consists of making a small incision through the body and into a blood vessel and then maneuvering a guide wire through the vascular system to a point beyond the stenosis or occlusion.
A hollow catheter with a deflatable balloon near its distal end is threaded over the guide wire and advanced to the point of stenosis or occlusion. The balloon is then inflated and deflated several times to widen the constricted area, and is then withdrawn from the body.
Unfortunately, although the angioplasty procedure does markedly reduce the area of stenosis or occlusion, many patients exhibit a reoccurrence of the stenos s withir.a few mcnths of the original procedure.
Although the orisinal stenosis occurs by means of the bu ld up of placue over a relatively long period cf time, experime~tation has lead many to believe that the reoccurrence of the stenosis afte- the orisinal angioplasty procedure is urre'ated to the cause of the original stenosis. It is believed that the inflation of the balloon catheter ~sed in the angio-plasty procedure or the placement of a stent in the area of the stenosis causes irritation to the blood vessel. This irritation produces a mechanism of action called hyperplasia, inducing the inner layer of the blocd vessel cells to rapidly reproduce, the~eby calsing restenosis. It has been proposed that if the b'ood vessel is irradiated a. the point of the stenosis wi.h a radioactive dose, the mechanism that causes hyperplasia would be destrcyed without harming the blood vessel itself.
Dur-ng this procecure, it is important to precisely ccntrol the amount of radiation which is directed to the blood vessel wall, since too much radiation could actually induce hyperplasia as well as destroying a portion of the blood vessel, making it possible for an aneurism or rupture to occur. U.S.
Patent 5,213,561 issued to Weinstein et al and U.S. Patent 5,199,939 issued to Dake et al, as well as PCT Application PCT/US92/07447 to Shefer et al, describe various methods and apparatus for introducing radiation to the site of a stenosis to endeavor to prevent restenosis.
The Weinstein et al patent describes a method and apparatus for preventing restenosis after angioplasty. A balloon -catheter transported by a conventional guide wire is delivered to the location of the stenosis. Particles or crystals of radioactive material are embedded or mounted on a tube provided inside the balloon catheter. A retractable radiation shielding sleeve is slidable along the tube to cover the source of radioactive material. Upon completion of the angioplasty, the shielding sleeve is retracted and the area of the stenosis is irradiated. Although this apparatus does introduce radiation to the point of the stenosis, the retractable shielding surrounding the source of radioactive material makes this catheter bulky and unwieldy to use. In this regard, it is very doubtful that a cathe.er system this bulky would fit into the smaller branches or vessels of the hea-t. It is also doubtful that a catheter t~is bu-lky anc stiff could be maneuverec throuch the tlghter ber.ds ar.d turns in many of the vessels.
An additional embodiment of the Weinstein et al patent illustrGt~s a stent which is made of or coatea with a radioactive materia' such as ir-dium 192. Since the radioactive mate-ial is provided on the outer surface of the stent, it is very difficult to precisely administer the proper dosaae of radiation to prevent hyperplasia without administering a level of radiation which wou'd ac~ually induce hyperplasia or othe- deleterious effects to the blood vessel.
The PCT application illustrates a method and apparatus fo~ res.enosis treatment by applying a radioactive dose to the stenosed resion after reduction of the reg on by angioplasty or other means. As shown in FIG. 4, an anaioplasty balloon is expanded in the vicinity of a lesion site and radioactive elements provided on the exterior surface of the balloon are forced into contact with the region. Therefore, similar to the Weinstein et al patent, the presence of the radioactive material on the exterior of the catheter would make it very difficult to apply the precise amount of radiation to the region of interest.
Additionally, both the PCT application as well as the patent to Weinstein describe balloon catheters which do not allow the blood within the vessel to flow during inflation of the balloon.
Although there have been some attempts to construct a ~dilatation balloon allowing for some perfusion of bodily fluids during the inflation phase of the dilatation, the perfusion is greatly di~linished by the overall size of the inflated balloon.
Dilatation balloons must be able to hold a great amount of pressure (up to 16 atmospheres) and must also be able to inflate to large overall diameters to open the stenosis areas inside the bodily conduits or narrow tortuous passageways. Both of these requirements lead to large, bulky dilatation balloons that encompass most, if not all, of the area inside the stenosed vessel leading to large blockages of bodily fluids and thus allowing for little, if any perfusion.

These types of balloons are described in U.S. Pa~ent Nos. 5,295,959, issued to Gurbel et al ana 5,308,356, issued to Blackshear, Jr. et al. Both of these patents describe a passlve pe;fusion dilatation catheter havins a se-ies of non-longitucinal s lobes. As particularly illustrated in FIG. 1 of the Blackshear, Jr. et al patent, vi-tually the entire interior of the bodily conduit is b'ocked when the dilat2tion balloon is inflated, thereby preventinS the flow of bodily fluids around the treatment site. Additionally, due to the particular structure Ct the balloons utilized, neither the Gu~bel et al nor the Blackshea-, Jr. et al balloon can be use~ to preciselv center the catheter within the bodily conduit at the site of treatment.
Attempts to utilize these types of dilatation balloons as a center-ns ba'loon or treatins the pat-ent with radioactive materials would greatly compromise the patient for the many minutes while the treatment is being implemented due to the aiminished flow o, bodily fluids or, in some cases, the complete klockage of bodily fluids. Any compromises to the dilatation balloon to achieve a greater flow rate would greatly decrease the effecti~eness of the balloon on the stenosed area.
Therefore, there exists a need for a balloon catheter system that will achieve the greatest amount of dilatation possible and would also allow for the centering of the treatment lumen inside the bodily conduit or passageway while allowing for the maximum flow rate of bodily fluids around the treatment site.
The patent to Dake et al shows a radioactive catheter for preventing restenosis after angioplasty. However, this patent merely indicates that an elongated flexible catheter is transporte~ to the area of the original stenosis after a balloon catheter has been withdrawn, thereby lengthening the time to administer the entire procedure.

S ~ RY OF THE lNV~:NllON
These anc. other deficiencies of the prior art are acdresse~ by the present invention which is directed to a method arc apparatus for treating the location of a stenosis in a blood vessel, or other hollow conduit or narrow tortuous passageway in the bocy. A radiopaque elongated, flexible guide wire is inse~ted ir,to the body through a small incision and is then introduced into a blood vessel or similar conduit or passageway.
Once in place, a catheter having a dilatation balloon (or series of balloons3 and a centering balloon (or series of balloons) both a_-achec. near the distal end thereof is threaded over the guide w--e and is also acvanced to the location of treatment. The dilatation balloon or balloons is inflated and deflated one or mc-e times to reduce the size of the stenosis. At this point, the centering balloon or balloons would be inflated. Since the centerinS balloons in late svmmetrically and are long with thin widths, they serve only to cente- the treatment lumen of the catheter inside the prior stenosed area while allowing for maximum bodily perfusion. A radioactive source or sources is advanced into position through the treatment lumen of the catheter to the site of the original stenosis. With the centering balloon or balloons inflated, the catheter and the radioactive source or sources are correctly centered within the bcdily conduit or passageway to administer the precise dose to the original area of the stenosis. After a predetermined period of time has elapsed, the centering balloon or balloons are . deflated and the radioactive source as well as the catheter and the guide wire are removed from the bodily conduit or passageway.
A second embodiment of the present invention would include a flexible membrane attached to either the dilatation balloon or the centering balloon to further insure that blood will be able to flow through the perfusion channels through each of the lobes of a multi-lobed dilatation balloon thereby assuring that plaque or other material would not clog these channels.
Finally, if the catheter is used to transport a source of radiation to the treatment site without the necessity of reducing the size of a stenosis, the dilatation balloon need not ; CA 02213384 1997-08-20 be attached to the catheter. In this situation, the cathete-would only include the centering balloon which would be inflated during the time the rad~ation source or sources are maneuvered to the treatment site as well as during the treatment period.
After a predetermined period of time, the centering balloon is deflated and the catheter, guide wire and radiation source are removed from the body.

8RIEF DESCRIPTION OF T~E DRAWINGS
The above and other objects, features and advantages of the present invention will become apparent from the following desc_iption and the appended claims, taken in conjunction with the accompanyins drawings, in which:

FIG. 1 is a longitudinal sectional view of the balloor, catheter passing over a guide wire wherein the guide wire passes through a lumen inside the wall of the catheter;

~ IG. 2 is a longitudinal sectional view of the balloon catheter passing over a guide wire wherein the guide wire passes through an opening in the wall of the catheter and rurs along the outside of the catheter;

FIG. 3 is a cross-sectional view of FIG. 1 showing the gl~ide wire lumen and two inflation lumens inside the wall of the catheter and an inner treatment lumen of the catheter;

FIG. 4 is a cross-sectional view of FIG. 2 showing the guide wire on the outside of the catheter, two inflation lumens inside the wall of the catheter and an inner treatment lumen of the catheter;

FIG. 5 is transverse cross-sectional view of an infiated multi-lobed dilatation balloon catheter;
.
FIG. 6 is transverse cross-sectional view of an inflated m~ulti-lobed dilatation balloon catheter surrounded by a flexible sheath member;

FIG. 7 is transverse cross-sectional view of an inflated multi-lobed centering balloon catheter;

FIG. 8 is transverse cross-sectional view of an inflated multi-lobed centering balloon catheter surrounded by a flexible sheath member;

CA 02213384 1998-01-0~

FIG. 9 iS a cross-sectional view showing a three-lobe deflated centering balloon and a three-lobe deflated dilatation balloon each attached about the same area to a catheter;

FIG.10 is a cross-sectional view showing an inflated three-lobe centering balloon attached to a deflated dilatation balloon that is attached to a catheter;

FIG. 11 is a longitudinal view of a multi-lobe long-tudinal centering balloons; and FIG. 12 is a longitudinal view of a multi-lobe segmented centering balloons.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Although the present invention can be used to treat blockases, occlu~ion or constricticn in many boay c~nauits as well as narrow tortuous passageways, for ease of explanatior., the present invention will be discussed with respect to a stenosis provided in a blood vessel. Additionaliy, also for ease of explanatioh, the same refe-ence numeral would be used for like features.
Referring to FIG. 1 and FIG. 2, the cathete- system 10 of the present invention includes a flexibie, elongated catheter 12 havina a relatively large hcllow treatment lumen 13 runnins the ma,ority of the le-.gth of the cathete~. An elongated, flexi le guide wire 16 is to be used to ins_re that the catheter 12 is maneuvered to the proper location to treat the stenosis.
In the embodiment shown in FIG. 1, a guide wire lumen 22 is pro~lded adjacent to one of the surfaces c. the trea_ment lumen 13. The second embodiment shown in FIG. 2 shows the guide wire 16 pass ng on the outside of catheter. The guide wire 16 would enter the interior of the catheter by passi-.g through an opening 19 provided at the termination of the distal end of the catheter.
The guide wire then passes through slot 24 close to the distal end 15 of the catheter and runs along the outside surface of the treatment lumen 13. The distal end of the catheter end 15 is tapered at 18 to allow ease of maneuverability of the catheter through the narrow conduit or passageway.
The catheter according to the present invention would be used to reduce the size of any stenosis by inflating and ~deflating a dilatation balloon 14 affixed to the outside surface of the catheter. Radiopaque markings (not shown) are provided on the exterior surface of the catheter at approximately the beginning and the end of the location of the balloon or balloons.
The present invention could also utilize one or more centering balloons, the purpose of which will be described hereinbelow.
Furthermore, it is noted that it would be possible to utilize this catheter with only the centering balloon or balloons and not employ the dilatation balloon 14 if the stenosis would not be reduced by inflating and deflating the dilatation balloon.

Once the catheter is maneuvered to the treatment site, a radiation source or sources 28 would be maneuvered th-oush the tre2tmen~t lumer. 13 utilizins a guide type wire 30 contGin~ns the radiatior.so~rce or sources. It is noted that if a stenosis must s be reduce~, the d~latation ballocn 14 would be inflatec' and deflated a number of times. Once the stenosis is reduced, the dilutation balloon is deflated completely and the centering balloon or balloons would be inflated. At this point, the radiation source or sources 28 would be maneuvered to the treatment site utilizing the radiopaque mar~ings. Various types o rad ation sources ~own in the art could be utilized with this treatment. Ty-~ical of these radiation sources would be cesium 137, cobalt 60, iodine 125, iodine 131, cobalt 57, iridium 192, so'd 198, palladium 103, strontium 89, strontium 90, phosphate 32 or yttrium 90. A solid plug 26 is provided in a distal end of a catheter at the point where the catheter besins to taper to insure that the radiation source 28 remains within the interior of the cathete_, and that contamination or ge~ms provided within the treatment lumen 13 do not mix with bodily fluids provided within the passageway.
FIGS. 5-8 show a multi-lobed centering balloon as well as a multi-lobed dilatation balloon in various states of inflation or deflation. More specifically, FIG. 5 shows the dilatation balloon 14 provided with its four lobes 36, 38, 40 and 42 in the inflated state. As shown in FIG. 1 and FIG. 2, this balloon is attached to the exterior surface of the catheter 12.
-FIG. 5 also shows a multi-lobed centering balloon 41 having four lobes 44, 46, 48 and 50 in its deflated state. It should be noted that the exact number of lobes of both the dilatation balloon 14 and the centering balloon 41 are not crucial. For that matter, it is noted that the dilatation balloon 14 can be constructed without any lobes. In this situation, the inflation of the dilatation balloon 14 to reduce the size of the stenosis would thereby prevent the perfusion of bodily fluids during the time when this balloon is in its inflated state.
FIG. 7 and FIG. 8 show the dilatation balloon 14 in its deflated state, and the centering balloon 41 in its inflated state. As can be shown, the lobes 44, 46, 48 and 50 of the centering balloor 41 a-e relati~ely thin in volume and would ex.e~.c sym~etricaally from the su~ ace of the catheter 12 as a plurality of radiating spokes or thin longitudinal lobes until it abuts the inne_ surface of the passageway. When the dilata-tion balloon 14 is inflated, it would fill ap?roximately 90-100 of the passageway th~s allowing for llttle, if any, bodily fluids to perfuse by. When the dilatation balloon 14 is deflated and the centering balloon 41 is inflated, only approximately 30-50~
of the passaseway would be blocked, thus allowing for bodily flui~s to easily perfuse by. Both the dilatation balloon 14 and the centering balloon 41 would be manufac ured from materials star,dard in the industry. This would also be true for the guide wire 16 as well as the catheter 12.
FIG. 6 and FIG. 8 illustrate the utilization of a memb_ar.e or shea-h 52 which is used tc achieve a greater d latation affect while allowing for a better blood pe-fusion and the centering of the t-eatment source. S-nce placue or other bodily material can plug the perfusion channel or channels between adjacent lobes of the dilatation balloon 14, it is importar.t that the channels between each of the lobes remain free of this material to allow bodily fluid, such as blood, to pass freely between these channels. This is especially true during an angioplasty procedure.
The present invention would overcome this problem by employins the membrane or sheath 52 which would surround the -entire ribbed balloon. This membrane or sheath 52 would extend for either the entire length of the balloon 14 or for a portion of the length of the balloon 14. Once the balloon 14 is inflated, the membrane or sheath would be pulled tight between the gaps of the balloon lobes, as the lobes are inflated.
This particular configuration would result in a greater dilatation affect since plaque or other bodily material cannot enter the sap spaces and is forced to move away from the membrane and lobes as expansion takes place due to the inflation of the balloon lobes. Additionally, a perfusion channel or channels is maintained open and bodily fluids will flow freely, since no bodily plaaue mate-iGl can enter the gap spaces to plug or create 2 damming affect.
The membrane can be cons,ructed frsm a non-elastic or non-stretching type of material such that a thick overall diameter is ach-eved when the balloon lobes are inflated.
Alte~r.atively, the ~embrane can alsc be constructed out of an elastic or stretching type of mate--al so that when the balloon lobes are deflated, the membrane will recoil to its orisinal shape and it is guaranteed that the balloon lobes will compress iO to as small of a diameter as possible around the catheter 12.
This compression would allow for the balloon catheter when it is in ts deflated s.ate to pass through tiny constricted spaces.
A stretchable membrane also allows for a thick diameter as long as the membrane cannot be stretched beyond the desired diameter of the inflated lobes.
Alternatively, although not specifically illustrated in the drawings, ~t is noted that the membrane or sheath 52 need not surround the entire surface area of the lobes but can be provided merely between the lobes. Similar to the previously described embodiment, this membrane can be constructed from a non-elastic or an elastic material. Furthermore, this membrane portion may cover the entire length of the balloor, 14 or a portion of the length of the balloon 14.
Furthermore, the membrane or sheath 52 would be attached to either the dilatation balloon 14 or the centering balloon 41.
~ Referring back to FIG. 1 and FIG. 2 as well as FIG. 3 and FIG. 4, the dilatation balloon 14 can be inflated or deflated through the use of a balloon inflation port 56. A lumen 32 within the catheter 12 connected to the balloon 14 and the port 56 is used for this purpose. The centering balloon 41 can be inflated utilizing balloon inflation port 54. A lumen 34 provided within the catheter 12 connected to the balloon 41 and the port 54 is used for this purpose. FIG. 3 is a partial cross-se~tional view of the catheter illustrated with respect to FIG.1 also showing the use of an internal lumen 22 for the guide wire 16. FIG. 4 is a partial cross-sectional view of the catheter shown in FIG. 2 in which the guide wire 16 extends for a pcrtion alono the exterior surface of the catheter 12.
F~G. 9 shows an embodiment in which a three-sided multi-lobed dilatation ballcon 14 is provided along the majority of the surface of the catheter 12. Spaces between each of the lobes would 211OW the various spokes 42 o~ lobes 41 of the centering balloon to pass therebetween. In this instance, the spokes 42 or lobes 41 of the centering balloon would be attached directly to the exterior surface of the catheter 12.
FIG. 10 shows an embodiment in which a non-lobed dilatation ballocn 14 is attached to the exterior surface of the cathete- 12. As illustrated in FIG. 10, the balloon 14 is in its deflated state. The cente-ing balloon 41 is shown in its inflated state in FIG. 10 and is attached to the exte-ior surface of the non-lobed ballocn 14.
FIG. 11 shows a multi-lobe longitudinal centering balloon system which contains a plurality of centering balloons 41, which extend longitudinally along the surface of the catheter.
FIG. 12 shows a multi-lobe segmented centering balloon system which contains a plurality of sets of centering balloons 42. This embodiment would allow for the maximum perfusion possible.
Although the present invention has been described with reference to specific details of certain embodiments thereof, it is not intended that such details should be regarded as limita--tions upon the scope of the invention except as and to the extent that they are included in the accompanying claims.

Claims

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. A treatment device comprising:

a flexible, elongated catheter having a distal end and a proximal end, said catheter including a first hollow treatment lumen extending within said catheter and having an exterior surface;
a centering balloon attached to said exterior surface proximate to said distal end of said catheter, said centering balloon including at least two inflatable spokes, said spokes encircling said distal end around a first particular point;
wherein when inflated, said centering balloon permits perfusion of bodily fluids around said spokes.

2. The device in accordance with claim 1, further comprising a source of radiation positioned within said hollow treatment lumen.

3. The device in accordance with claim 1 further comprising a flexible membrane attached to said centering balloon, said flexible membrane sized and configured to contact a body wall when said centering balloon is inflated.

4. The device in accordance with claim 1, wherein said centering balloon includes at least one additional set of inflatable spokes encircling a portion of said outer surface of said catheter, each of said additional sets of inflatable spokes encircling said outer surface at a point removed from said first particular point, each of said additional spokes of a particular set of additional spokes being symmetrically spaced from one another.

5. The device in accordance with claim 1 further comprising a second lumen provided within said catheter connected to said centering balloon.

6. The device in accordance with claim 1 further comprising a flexible, elongated guide wire and a third lumen provided within at least a portion of said catheter within which said guide wire is positioned.

7. The device in accordance with claim 1 further comprising a seal positioned within said distal end of said catheter.

8. The device in accordance with claim 1 wherein the distal end is tapered at said distal end.

9. The device in accordance with claim 2, wherein said source of radiation is cesium 137, cobalt 60, iodine 125, iodine 131, cobalt 57, iridium 192, gold 198, palladium 103, strontium 89, strontium 90, phosphate 32 or yttrium 90.

10. The device of claim 1, further comprising:
a dilatation balloon attached to and encircling a portion of said distal end of said catheter.

11. The device in accordance with claim 10 , wherein said dilatation balloon is provided with a plurality of longitudinally extending lobes whose distance from said exterior surface of said catheter is relatively constant when said dilatation balloon is inflated.

12. A treatment device, comprising:
a flexible, elongated catheter having a distal end and a proximal end, said catheter provided with a first hollow treatment lumen extending within said catheter and provided with an exterior surface;
a centering balloon attached to said exterior surface proximate to said distal end of said catheter, said centering balloon including at least two inflatable longitudinal balloons.

13. The device in accordance with claim 12 in which said longitudinal balloons are equally spaced from one another around said exterior surface of said catheter.